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Costa BA, Mouhieddine TH, Ortiz RJ, Richter J. Revisiting the Role of Alkylating Agents in Multiple Myeloma: Up-to-Date Evidence and Future Perspectives. Crit Rev Oncol Hematol 2023; 187:104040. [PMID: 37244325 DOI: 10.1016/j.critrevonc.2023.104040] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023] Open
Abstract
From the 1960s to the early 2000s, alkylating agents (e.g., melphalan, cyclophosphamide, and bendamustine) remained a key component of standard therapy for newly-diagnosed or relapsed/refractory multiple myeloma (MM). Later on, their associated toxicities (including second primary malignancies) and the unprecedented efficacy of novel therapies have led clinicians to increasingly consider alkylator-free approaches. Meanwhile, new alkylating agents (e.g., melflufen) and new applications of old alkylators (e.g., lymphodepletion before chimeric antigen receptor T-cell [CAR-T] therapy) have emerged in recent years. Given the expanding use of antigen-directed modalities (e.g., monoclonal antibodies, bispecific antibodies, and CAR-T therapy), this review explores the current and future role of alkylating agents in different treatment settings (e.g., induction, consolidation, stem cell mobilization, pre-transplant conditioning, salvage, bridging, and lymphodepleting chemotherapy) to ellucidate the role of alkylator-based regimens in modern-day MM management.
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Affiliation(s)
- Bruno Almeida Costa
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo J Ortiz
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Richter
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Habas E, Akbar R, Farfar K, Arrayes N, Habas A, Rayani A, Alfitori G, Habas E, Magassabi Y, Ghazouani H, Aladab A, Elzouki AN. Malignancy diseases and kidneys: A nephrologist prospect and updated review. Medicine (Baltimore) 2023; 102:e33505. [PMID: 37058030 PMCID: PMC10101313 DOI: 10.1097/md.0000000000033505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
Acute kidney injury (AKI), chronic renal failure, and tubular abnormalities represent the kidney disease spectrum of malignancy. Prompt diagnosis and treatment may prevent or reverse these complications. The pathogenesis of AKI in cancer is multifactorial. AKI affects outcomes in cancer, oncological therapy withdrawal, increased hospitalization rate, and hospital stay. Renal function derangement can be recovered with early detection and targeted therapy of cancers. Identifying patients at higher risk of renal damage and implementing preventive measures without sacrificing the benefits of oncological therapy improve survival. Multidisciplinary approaches, such as relieving obstruction, hydration, etc., are required to minimize the kidney injury rate. Different keywords, texts, and phrases were used to search Google, EMBASE, PubMed, Scopus, and Google Scholar for related original and review articles that serve the article's aim well. In this nonsystematic article, we aimed to review the published data on cancer-associated kidney complications, their pathogenesis, management, prevention, and the latest updates. Kidney involvement in cancer occurs due to tumor therapy, direct kidney invasion by tumor, or tumor complications. Early diagnosis and therapy improve the survival rate. Pathogenesis of cancer-related kidney involvement is different and complicated. Clinicians' awareness of all the potential causes of cancer-related complications is essential, and a kidney biopsy should be conducted to confirm the kidney pathologies. Chronic kidney disease is a known complication in malignancy and therapies. Hence, avoiding nephrotoxic drugs, dose standardization, and early cancer detection are mandatory measures to prevent renal involvement.
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Affiliation(s)
- Elmukhtar Habas
- Facharzt Internal Medicine, Facharzt Nephrology, Medical Department, Hamad General Hospital, Doha, Qatar
| | - Raza Akbar
- Medical Department, Hamad General Hospital, Doha, Qatar
| | - Kalifa Farfar
- Facharzt Internal Medicine, Medical Department, Alwakra General Hospital, Alwakra, Qatar
| | - Nada Arrayes
- Medical Education Fellow, Lincoln Medical School, University of Lincoln, Lincoln, UK
| | - Aml Habas
- Hematology-Oncology Department, Tripoli Children Hospital, Tripoli, Libya
| | - Amnna Rayani
- Facharzt Pediatric, Facharzt Hemotoncology, Hematology-Oncology Department, Tripoli Children Hospital, Tripoli, Libya
| | | | - Eshrak Habas
- Medical Department, Tripoli Central Hospital, University of Tripoli, Tripoli, Libya
| | | | - Hafidh Ghazouani
- Quality Department, Senior Epidemiologist, Hamad Medical Corporation, Doha, Qatar
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3
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Wang SY, Holzhey T, Heyn S, Zehrfeld T, Fricke S, Hoffmann FA, Becker C, Braunert L, Edelmann T, Paulenz I, Hitzschke M, Flade F, Schwarzer A, Fenchel K, Franke GN, Vucinic V, Jentzsch M, Schwind S, Hell S, Backhaus D, Lange T, Niederwieser D, Scholz M, Platzbecker U, Pönisch W. Impact of the changing landscape of induction therapy prior to autologous stem cell transplantation in 540 newly diagnosed myeloma patients: a retrospective real-world study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04184-x. [DOI: 10.1007/s00432-022-04184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022]
Abstract
Abstract
Introduction
Autologous stem cell transplantation (ASCT) is the standard treatment for younger patients with newly diagnosed multiple myeloma (MM). However, due to restrictive exclusion criteria, more than half of eligible patients are usually excluded from transplant studies.
Methods
This retrospective monocentric analysis included 540 patients with MM who received an ASCT between 1996 and 2019.
Results
Up to 2005, induction therapy consisted mainly of conventional chemotherapies, e.g. vincristine/doxorubicin/dexamethasone (VAD). In the following years, the triple-combinations based on bortezomib coupled with doxorubicin/dexamethasone (PAD), melphalan/prednisolone (VMP), cyclophposphamide/dexamethasone (VCD) or bendamustine/prednisolone (BPV) became the most popular treatment options. A progressive improvement in PFS was observed in patients treated with the two current induction therapies BPV (47 months) or VCD (54 months) compared to VAD (35 months, p < 0.03), PAD (39 months, p < 0.01 and VMP (36 months, p < 0.01). However, there was no significant difference in median OS (VAD 78, PAD 74, VMP 72, BPV 80 months and VCD not reached). In our analysis, we also included 139 patients who do fulfill at least one of the exclusion criteria for most phase 3 transplant studies (POEMS/amyloidosis/plasma cell leukemia, eGFR < 40 mL/min, severe cardiac dysfunction or poor general condition). Outcome for these patients was not significantly inferior compared to patients who met the inclusion criteria for most of the transplant studies with PFS of 36 vs 41 months (p = 0.78) and OS of 78 vs 79 months (p = 0.34).
Conclusions
Our real-world data in unselected pts also stress the substantial value of ASCT during the first-line treatment of younger MM pts.
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Braet P, Sartò GVR, Pirovano M, Sprangers B, Cosmai L. Treatment of Acute Kidney Injury in Cancer Patients. Clin Kidney J 2021; 15:873-884. [PMID: 35498895 PMCID: PMC9050558 DOI: 10.1093/ckj/sfab292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
Acute kidney injury (AKI), either of pre-renal, renal or post-renal origin, is an important complication in cancer patients, resulting in worse prognosis, withdrawal from effective oncological treatments, longer hospitalizations and increased costs. The aim of this article is to provide a literature review of general and cause-specific treatment strategies for AKI, providing a helpful guide for clinical practice. We propose to classify AKI as patient-related, cancer-related and treatment-related in order to optimize therapeutic interventions. In the setting of patient-related causes, proper assessment of hydration status and avoidance of concomitant nephrotoxic medications is key. Cancer-related causes mainly encompass urinary compression/obstruction, direct tumoural kidney involvement and cancer-induced hypercalcaemia. Rapid recognition and specific treatment can potentially restore renal function. Finally, a pre-treatment comprehensive evaluation of risks and benefits of each treatment should always be performed to identify patients at high risk of treatment-related renal damage and allow the implementation of preventive measures without losing the potentialities of the oncological treatment. Considering the complexity of this field, a multidisciplinary approach is necessary with the goal of reducing the incidence of AKI in cancer patients and improving patient outcomes. The overriding research goal in this area is to gather higher quality data from international collaborative studies.
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Affiliation(s)
- Pauline Braet
- Division of Nephrology, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Giulia Vanessa Re Sartò
- Onconephrology Outpatients Clinic, Nephrology and Dialysis, ASST Santi Carlo e Paolo, Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Marta Pirovano
- Onconephrology Outpatients Clinic, Nephrology and Dialysis, ASST Santi Carlo e Paolo, Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Ben Sprangers
- Division of Nephrology, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Laura Cosmai
- Onconephrology Outpatients Clinic, Nephrology and Dialysis, ASST Santi Carlo e Paolo, Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
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Prognostic impact of rapid reduction of involved free light chains in multiple myeloma patients under first-line treatment with Bendamustine, Prednisone, and Bortezomib (BPV). J Cancer Res Clin Oncol 2021; 147:2349-2359. [PMID: 33433659 PMCID: PMC8236483 DOI: 10.1007/s00432-020-03504-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/12/2020] [Indexed: 11/09/2022]
Abstract
Introduction Light chain involvement is observed in almost every patient (pt) with newly diagnosed multiple myeloma (MM). Owing to a relatively short half-life, rapid reduction in the involved free light chain (iFLC) is of potential prognostic value. Methods This retrospective analysis included 92 pts with newly diagnosed MM treated with bendamustine, prednisone, and bortezomib (BPV). Results After a median number of two (range 1–5) BPV cycles, the majority of pts (n = 86; 93%) responded with either sCR (n = 21), CR (n = 1), nCR (n = 25), VGPR (n = 20), or PR (n = 19). PFS and OS at 48 months were 39% and 67%, respectively. At baseline, 79 out of 92 pts (86%) had iFLC levels above the upper standard level and an abnormal ratio of involved to uninvolved free light chain ≥ 8. In a subgroup analysis of these pts, we evaluated the prognostic importance of an early reduction of the iFLC during the first two BPV cycles. A reduction ≥ 50% of the iFLC on day 8 of the first cycle was observed in 31 of 69 pts. These pts had a significantly better median PFS of 49 months as compared to 20 months in 38 pts with a lower iFLC reduction (p = 0.002). In contrast, OS did not differ significantly with a 48 months survival of 77% vs 69% (p > 0.05). Conclusion These results indicate that a rapid decrease in the iFLC on day 8 is an early prognostic marker for newly diagnosed MM pts undergoing BPV treatment.
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Knauf W, Dingeldein G, Schlag R, Welslau M, Moehler T, Terzer T, Walter S, Habermehl C, Kunz C, Goldschmidt H, Raab MS. First-line therapy with bendamustine/prednisone/bortezomib-A GMMG trial for non-transplant eligible symptomatic multiple myeloma patients. Eur J Haematol 2020; 105:116-125. [PMID: 32155662 DOI: 10.1111/ejh.13409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The German-speaking Myeloma Multicenter Group (GMMG) conducted this trial to investigate efficacy and safety of the three-drug combination bendamustine/prednisone/bortezomib (BPV) as first-line therapy for elderly patients with multiple myeloma (MM). METHODS Elderly MM patients requiring first-line therapy and not eligible for intensive treatment were enrolled in this phase IIb multicenter study. Patients were treated with BPV regimen for a maximum of nine cycles. RESULTS Forty-six patients were included in the trial with a median age of 76 years. Nineteen patients had renal impairment at baseline. The ORR was 78.8% for patients treated with 3 and more BPV cycles and 71.1% for all evaluable patients. The median progression-free survival was 25 months, and overall survival at 24 months was 83.3%. The clinical benefit rate including MR was 91.2%. In patients with renal impairment at baseline, a renal response was observed in 11 pts. with complete recovery of the renal function in six patients. The most frequent CTC grade 3/4 AEs experienced by patients were hematological (17.5%) and infectious (9.8%) complications. No new safety signals were observed for the study drugs under investigation. CONCLUSIONS Bendamustine/prednisone/bortezomib may serve as a first-line regimen for transplant-ineligible elderly MM patients in particular for patients with renal impairment requiring a fast and durable renal response.
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Affiliation(s)
- Wolfgang Knauf
- Centrum Haematologie & Onkologie Bethanien, Frankfurt, Germany
| | | | - Rudolf Schlag
- Hämatologisch-Onkologische Schwerpunktpraxis, Würzburg, Germany
| | | | | | - Tobias Terzer
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Sarah Walter
- Koordinierungszentrum für klinische Studien Heidelberg, FRG, Heidelberg, Germany
| | - Christina Habermehl
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Christina Kunz
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Marc-Steffen Raab
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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7
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Lentzsch S, Lagos GG, Comenzo RL, Zonder JA, Osman K, Pan S, Bhutani D, Pregja S, Sanchorawala V, Landau H. Bendamustine With Dexamethasone in Relapsed/Refractory Systemic Light-Chain Amyloidosis: Results of a Phase II Study. J Clin Oncol 2020; 38:1455-1462. [PMID: 32083996 DOI: 10.1200/jco.19.01721] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE No established treatments exist for relapsed/refractory systemic light-chain (AL) amyloidosis. Bendamustine has shown potential in the treatment of multiple myeloma. We conducted a phase II, multicenter trial to assess the efficacy and safety of bendamustine with dexamethasone (ben-dex) in patients with persistent or progressive AL amyloidosis after ≥ 1 prior therapy. METHODS The trial enrolled 31 patients who received bendamustine on days 1 and 2 (100 mg/m2 intravenously) with 40 mg of weekly dexamethasone in 28-day cycles until disease progression or up to 6 cycles after complete hematologic response. The primary objective was the rate of partial hematologic response (PR) or better. RESULTS Patients received a median of 4 cycles (range, 2-12 cycles) with 57% of patients achieving a PR or better (11% complete response, 18% very good PR). The overall organ response was 29% among the 24 patients who had measurable organ involvement. Treatment was well tolerated with no grade 5 treatment-related adverse events (AEs). Sixty-five percent of patients had a therapy-related grade 3-4 AE. The most common AEs included myelosuppression, fatigue, and nausea/vomiting. The median overall survival was 18.2 months (95% CI, 11.3 to 43.8 months), and hematologic response was associated with prolonged survival (P = .0291). The median progression-free survival was 11.3 months (95% CI, 5.0 to 15.4 months). CONCLUSION Overall, ben-dex is a viable treatment option with substantial efficacy and limited toxicity for patients with pretreated AL amyloidosis who have limited therapeutic options. This trial was registered at (ClinicalTrials.gov identifier: NCT01222260).
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Affiliation(s)
- Suzanne Lentzsch
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | - Galina G Lagos
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | | | - Jeffrey A Zonder
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Keren Osman
- Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - Samuel Pan
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | - Divaya Bhutani
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | - Silva Pregja
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Heather Landau
- Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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8
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Rosner MH, Perazella MA. Acute kidney injury in the patient with cancer. Kidney Res Clin Pract 2019; 38:295-308. [PMID: 31284363 PMCID: PMC6727896 DOI: 10.23876/j.krcp.19.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/05/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023] Open
Abstract
Dramatic advances in the care of patients with cancer have led to significant improvement in outcomes and survival. However, renal manifestations of the underlying cancer as well as the effects of anti-neoplastic therapies leave patients with significant morbidity and chronic kidney disease risks. The most common renal manifestations associated with cancer include acute kidney injury (AKI) in the setting of multiple myeloma, tumor lysis syndrome, post-hematopoietic stem cell therapy, and AKI associated with chemotherapy. Knowledge of specific risk factors, modification of risk and careful attention to rapid AKI diagnosis are critical for improving outcomes.
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Affiliation(s)
- Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA
| | - Mark A Perazella
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
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9
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Gomez-Arteaga A, Mark TM, Guarneri D, Christos PJ, Gergis U, Greenberg JD, Hsu J, Mayer SA, Niesvizky R, Pearse RN, Phillips AA, Rossi A, Coleman M, van Besien K, Shore TB. High-dose bendamustine and melphalan conditioning for autologous stem cell transplantation for patients with multiple myeloma. Bone Marrow Transplant 2019; 54:2027-2038. [PMID: 31190006 DOI: 10.1038/s41409-019-0587-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 11/09/2022]
Abstract
High-dose melphalan (MEL200) followed by autologous stem cell transplantation (ASCT) remains a standard of care for multiple myeloma (MM). Bendamustine induces responses in MM resistant to other alkylators. Our prior Phase I trial adding bendamustine to MEL200 transplant conditioning resulted in no additional toxicity. We now report a single-arm, phase II study that evaluated the efficacy of bendamustine 225 mg/m2 with MEL200 conditioning for ASCT in 18 patients with newly diagnosed MM (NDMM) and 17 with relapsed or refractory MM (RRMM). The primary end point was the complete response (CR/sCR) rate at day+ 100. Sample size was determined according to Simon's two-stage design. At stage 1, sixteen patients entered the study. As there were eight patients with CR/sCR, enrollment increased to 28 patients. Sixteen out of the first 28 evaluable patients achieved CR/sCR, meeting the design criteria. Enrollment was then expanded to a total of 35 patients. 51% achieved a CR/sCR. After a median follow-up of 65 months, 21 patients progressed, including 7 deaths. The median PFS for NDMM and RRMM was 48 and 45 months, respectively. Bendamustine/MEL200 conditioning resulted in excellent overall and depth of response as well as PFS, particularly in the RRMM patients, and is worthy of further investigation (NCT00916058).
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Affiliation(s)
- Alexandra Gomez-Arteaga
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
| | - Tomer M Mark
- Department of Medicine, Division of Hematology, University of Colorado - Anschutz Medical Campus, New York, NY, USA
| | - Danielle Guarneri
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Paul J Christos
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Usama Gergis
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - June D Greenberg
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Jingmei Hsu
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Sebastian A Mayer
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Ruben Niesvizky
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Roger N Pearse
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Adrienne A Phillips
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Adriana Rossi
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Morton Coleman
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Koen van Besien
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Tsiporah B Shore
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
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Manohar S, Nasr SH, Leung N. Light Chain Cast Nephropathy: Practical Considerations in the Management of Myeloma Kidney-What We Know and What the Future May Hold. Curr Hematol Malig Rep 2018; 13:220-226. [PMID: 29725932 DOI: 10.1007/s11899-018-0451-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To update and evaluate the current knowledge on pathogenesis and management of light chain cast nephropathy. Light chain cast nephropathy (LCCN) is the leading cause of acute renal failure in patients with multiple myeloma and is currently recognized as a myeloma defining event. RECENT FINDINGS The immunoglobulin free light chain plays an integral role in the pathogenesis of LCCN. The level of free light chain (FLC) in the blood and urine is directly associated with the risk of developing LCCN. Recovery of renal function is related to the speed and degree of the serum FLC reduction. Recently, two randomized trials using high cutoff dialyzer for the removal of serum FLC produced different results in terms of renal recovery. FLC plays a key role in the development and resolution of LCCN. Future therapies will aim to rapidly reduce its concentration or interrupt its interaction with Tamm-Horsfall protein.
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Affiliation(s)
- Sandhya Manohar
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology and Pathology Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55901, USA.
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11
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Abramson HN. The Multiple Myeloma Drug Pipeline-2018: A Review of Small Molecules and Their Therapeutic Targets. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:611-627. [PMID: 30001985 DOI: 10.1016/j.clml.2018.06.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 12/21/2022]
Abstract
Treatment of multiple myeloma (MM), a neoplasm of plasma cells, formerly dependent on alkylating drugs, corticosteroids, and autologous stem cell transplantation, has changed dramatically in the past 20 years because 3 new classes of small molecule drugs (arbitrarily defined as having a molecular weight of < 900 kDa)-immunomodulators, proteasome inhibitors, and histone deacetylase blockers-have been introduced for the disease. Therapeutic options for MM expanded further in 2015 when 2 new monoclonal antibodies (daratumumab and elotuzumab) were approved by the Food and Drug Administration for MM. Although MM remains incurable, the cumulative effect of these advances has resulted in a near-doubling of the 5-year survival rate since the late 1980s. Despite these advances, therapy for MM continues to pose substantial challenges because resistance to therapy frequently develops, and relapse and recurrence are all too common. The present review focused on the pipeline for new small molecules in various stages of development and their associated cellular targets. In addition to newer versions of alkylators, immunomodulators, proteasome inhibitors, and histone deacetylase inhibitors, the present review considered the prospects for adding new classes of small molecules to the MM armamentarium, which offer the potential for oral efficacy, relative simplicity of preparation, and prospects for improvement in the cost-to-benefit ratio. Included are agents that affect myeloma epigenetics and the ubiquitination-proteasome system and the unfolded protein response, apoptotic mechanisms, chromosomal abnormalities, nuclear protein transport, and various kinases involved in cellular signaling pathways.
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Affiliation(s)
- Hanley N Abramson
- Department of Pharmaceutical Sciences, Wayne State University, Detroit, MI.
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12
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Yalnız FF, Akkoç N, Salihoğlu A, Ar MC, Öngören Ş, Eşkazan AE, Soysal T, Aydın Y. Clinical Outcomes Related to the Use of Bendamustine Therapy for Multiple Myeloma Patients Relapsed/Refractory to Immunomodulatory Drugs and Proteasome Inhibitors. Turk J Haematol 2017; 34:233-238. [PMID: 28270368 PMCID: PMC5544042 DOI: 10.4274/tjh.2016.0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Multiple myeloma patients who are relapsed or refractory to both proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs) have been reported to have poor outcomes. Bendamustine has been reported to have an antitumor effect in newly diagnosed as well as relapsed/refractory multiple myeloma (RRMM). The aim of this retrospective study was to evaluate the efficacy of bendamustine therapy in heavily pretreated MM patients who were refractory to PIs and IMiDs. Materials and Methods: Nineteen RRMM patients treated either with bendamustine and steroids (n=13) or a combination of bendamustine with novel drugs (n=6) were included. The median number of previous treatment lines was 5 (minimum-maximum: 3-8) and median time from diagnosis was 6 years (minimum-maximum: 1-16). All of the patients were resistant to at least one of the IMiDs and one of the PIs. Bendamustine was given at doses ranging from 90 mg/m2 to 120 mg/m2 on days 1 and 2 of 28-day cycles. Results: A median of 2 (minimum-maximum: 1-8) treatment cycles was administered per patient. The toxicity of bendamustine was mild and mostly of hematological origin. No complete remission was achieved. There was partial remission and stable disease in 21% and 11% of the patients, respectively. Sixty-eight percent of patients had progressive disease. The median progression-free survival and overall survival was 2 and 4 months, respectively. Conclusion: Bendamustine therapy was well tolerated but showed limited anti-myeloma activity in heavily pretreated patients who were refractory to IMiDs and PIs.
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Affiliation(s)
- Fevzi Fırat Yalnız
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
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13
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Gordon MJ, Lewis LD, Brown JR, Danilov AV. Bendamustine hydrochloride in patients with B-cell malignancies who have comorbidities - is there an optimal dose? Expert Rev Hematol 2017; 10:707-718. [PMID: 28664772 DOI: 10.1080/17474086.2017.1350166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The majority of patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) present with comorbidities. Many of them are poor candidates for intensive chemo-immunotherapy regimens, such as FCR (fludarabine, cyclophosphamide, rituximab). Still, most clinical trials aim to enroll 'fit' patients, who poorly represent the community oncology population. Areas covered: In the past decade, bendamustine hydrochloride, a cytotoxic agent with structural similarities to both alkylating agents and purine analogs, has received widespread use in therapy of NHL and CLL, and has demonstrated a relatively favorable toxicity profile. However, bendamustine has not been well studied in patients with hematologic malignancies who have comorbidities. Here we review the clinical data on use of bendamustine in older and unfit patients with NHL and CLL, and analyze whether there is an optimal dose of bendamustine in patients who have significant comorbidities, including renal dysfunction. Expert commentary: Reduced intensity regimens of bendamustine are effective in CLL patients with comorbidities and renal dysfunction. Even with the introduction of targeted therapies, bendamustine will likely continue to be an important therapeutic option in patients with comorbidities because of its tolerability, efficacy and cost.
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Affiliation(s)
- Max J Gordon
- a Department of Internal Medicine , Oregon Health & Science University , Portland , OR , USA
| | - Lionel D Lewis
- b Section of Clinical Pharmacology, Department of Medicine , The Geisel School of Medicine at Dartmouth and The Norris Cotton Cancer Center , Lebanon , NH , USA
| | - Jennifer R Brown
- c Department of Medical Oncology , Dana-Farber Cancer Institute , Boston , MA , USA
| | - Alexey V Danilov
- a Department of Internal Medicine , Oregon Health & Science University , Portland , OR , USA.,d Knight Cancer Institute , Oregon Health & Science University , Portland , OR , USA
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14
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Berdeja JG, Bauer T, Arrowsmith E, Essell J, Murphy P, Reeves JA, Boccia RV, Donnellan W, Flinn I. Phase II study of bendamustine, bortezomib and dexamethasone (BBD) in the first-line treatment of patients with multiple myeloma who are not candidates for high dose chemotherapy. Br J Haematol 2017; 177:254-262. [PMID: 28169430 DOI: 10.1111/bjh.14536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/23/2016] [Indexed: 12/01/2022]
Abstract
The combination of bendamustine, bortezomib and dexamethasone (BBD) was evaluated as a first-line therapy for multiple myeloma. The original treatment regimen of bendamustine 80 mg/m2 , days 1, 4; bortezomib 1·3 mg/m2 , days 1, 4, 8, 11; dexamethasone 40 mg, days 1, 2, 3, 4 on a 28-day cycle (up to 8 cycles) was efficacious but determined relatively toxic in an interim analysis. The regimen was amended to bendamustine 80 mg/m2 , days 1, 2; bortezomib 1·3 mg/m2 , days 1, 8, 15; dexamethasone 20 mg, days 1, 2, 8, 9, 15, 16 every 28 days (up to 8 cycles), then maintenance 1·3 mg/m2 IV bortezomib every 2 weeks. Fifty-nine patients were enrolled. Primary endpoint was complete response (CR) rate. The original schema was given for a median of 7 cycles (range 1-8); modified schema was given for a median of 8 cycles (range 1-8) plus maintenance. Overall response was 91%, CR was 9%. Median follow-up was 19·1 months; median progression-free survival was 11·1 months and 18·9 months on the original and modified regimens, respectively. The most common Grade 3/4 adverse events were fatigue and neuropathy. The combination of BBD is tolerable and efficacious in this patient population. Modifications to decrease intensity but increase duration translated to better outcomes.
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Affiliation(s)
- Jesus G Berdeja
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - Todd Bauer
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - Edward Arrowsmith
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Chattanooga, TN, USA
| | - James Essell
- Sarah Cannon Research Institute, Nashville, TN, USA.,Oncology Hematology Care, Inc, Cincinnati, OH, USA
| | - Patrick Murphy
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - James A Reeves
- Sarah Cannon Research Institute, Nashville, TN, USA.,Florida Cancer Specialists, Ft. Myers, FL, USA
| | - Ralph V Boccia
- Center for Cancer and Blood Disorders, Bethesda, MD, USA
| | - William Donnellan
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - Ian Flinn
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
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15
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Zwickl H, Zwickl-Traxler E, Pecherstorfer M. A single-center retrospective analysis of first-line therapy of multiple myeloma with bendamustine-bortezomib-dexamethasone. Leuk Lymphoma 2016; 57:2065-70. [PMID: 26901249 DOI: 10.3109/10428194.2015.1126587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this retrospective study was to evaluate the efficacy and toxicity profile of bendamustine, bortezomib, and dexamethasone (BBD) combination treatment of patients with newly diagnosed multiple myeloma (MM). BBD treatment had a response rate of 80% regarding patients with ≥ partial response (PR). Median time to best response was 87.5 days and PFS was 22 months. Median of OS was not reached. PFS of non-responding patients was significantly shortened compared to those with ≥ PR. No statistically significant differences were determined concerning age (≥ vs. < 68 years) and ISS stage (ISS stage I/II vs. III). Grade 3 hematological effects and grade 3/4 non-hematological effects occurred in 20% and 35% of patients, respectively. Most pronounced hematological adverse event was leukopenia, the most severe non-hematological ones affected the cardiovascular system. In summary, BBD treatment was of acceptable efficacy in patients with newly diagnosed MM and exhibited rather low toxicity.
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Affiliation(s)
- Hannes Zwickl
- a Karl Landsteiner Society, Institute for Supportive Care in Cancer , Krems , Austria
| | - Elisabeth Zwickl-Traxler
- b Departement of Internal Medicine II, University Hospital Krems, Karl Landsteiner University of Health Sciences , Krems , Austria
| | - Martin Pecherstorfer
- b Departement of Internal Medicine II, University Hospital Krems, Karl Landsteiner University of Health Sciences , Krems , Austria
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16
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Mina R, Cerrato C, Bernardini A, Aghemo E, Palumbo A. New pharmacotherapy options for multiple myeloma. Expert Opin Pharmacother 2015; 17:181-92. [PMID: 26684262 DOI: 10.1517/14656566.2016.1115016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Novel agents and the availability of autologous stem-cell transplantation have revolutionized the treatment of patients with multiple myeloma. First-generation novel agents namely thalidomide, lenalidomide, and bortezomib have significantly improved response and survival of patients. Second-generation novel agents such as pomalidomide, carfilzomib, and monoclonal antibodies are being tested both in the newly diagnosed and relapse settings, and results are promising. AREAS COVERED In this review article, the main results derived from Phase III trials with thalidomide, lenalidomide, and bortezomib for the treatment of myeloma patients, both at diagnosis and at relapse, are summarized. Data about second-generation novel agents such as pomalidomide and carfilzomib are also reported. Newer effective drugs currently under investigation and the promising results with monoclonal antibodies are described. EXPERT OPINION The availability of new effective drugs has considerably increased the treatment options for myeloma patients. A sequential approach including induction, transplantation (when possible), consolidation, and maintenance is an optimal strategy to achieve disease control and prolong survival. Despite these improvements, the best combination, the optimal sequence, and the proper target of newer drugs need to be defined.
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Affiliation(s)
- Roberto Mina
- a Myeloma Unit , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| | - Chiara Cerrato
- a Myeloma Unit , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| | - Annalisa Bernardini
- a Myeloma Unit , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| | - Elena Aghemo
- a Myeloma Unit , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| | - Antonio Palumbo
- a Myeloma Unit , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
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17
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Cheson BD, Brugger W, Damaj G, Dreyling M, Kahl B, Kimby E, Ogura M, Weidmann E, Wendtner CM, Zinzani PL. Optimal use of bendamustine in hematologic disorders: Treatment recommendations from an international consensus panel - an update. Leuk Lymphoma 2015; 57:766-82. [PMID: 26592922 PMCID: PMC4840280 DOI: 10.3109/10428194.2015.1099647] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Bendamustine has achieved widespread international regulatory approval and is a standard agent for the treatment for chronic lymphocytic leukemia (CLL), indolent non-Hodgkin lymphoma and multiple myeloma. Since approval, the number of indications for bendamustine has expanded to include aggressive non-Hodgkin lymphoma and Hodgkin lymphoma and novel targeted therapies, based on new bendamustine regimens/combinations, are being developed against CLL and lymphomas. In 2010, an international panel of bendamustine experts met and published a set of recommendations on the safe and effective use of bendamustine in patients suffering from hematologic disorders. In 2014, this panel met again to update these recommendations since the clarification of issues including optimal dosing and management of bendamustine-related toxicities. The aim of this report is to communicate the latest consensus on the use of bendamustine, permitting the expansion of its safe and effective administration, particularly in new combination therapies.
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Affiliation(s)
- Bruce D Cheson
- a Lombardi Comprehensive Cancer Center, Georgetown University Hospital , Washington , DC , USA
| | - Wolfram Brugger
- b Schwarzwald-Baar Clinic, University of Freiburg , Villingen-Schwenningen , Germany
| | - Gandhi Damaj
- c University Hospital, University of Basse-Normandie , Caen , France
| | - Martin Dreyling
- d Medical Clinic, University Hospital of Munich , Munich , Germany
| | - Brad Kahl
- e University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Eva Kimby
- f Center for Hematology, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Michinori Ogura
- g Department of Hematology , Tokai Central Hospital , Gifu , Japan
| | - Eckhart Weidmann
- h Department of Oncology and Hematology , Krankenhaus Nordwest , Frankfurt , Germany
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18
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Mateos MV, Oriol A, Rosiñol L, de Arriba F, Puig N, Martín J, Martínez-López J, Echeveste MA, Sarrá J, Ocio E, Ramírez G, Martínez R, Palomera L, Payer A, Iglesias R, de la Rubia J, Alegre A, Chinea AI, Bladé J, Lahuerta JJ, San Miguel JF. Bendamustine, bortezomib and prednisone for the treatment of patients with newly diagnosed multiple myeloma: results of a prospective phase 2 Spanish/PETHEMA trial. Haematologica 2015; 100:1096-102. [PMID: 25911554 PMCID: PMC5004426 DOI: 10.3324/haematol.2015.124818] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/22/2015] [Indexed: 11/09/2022] Open
Abstract
Bendamustine is a bifunctional alkylating agent with proven activity in myeloma. In this study 60 newly diagnosed myeloma patients were given bendamustine plus bortezomib and prednisone in a regimen consisting of one cycle of bortezomib twice weekly for 6 weeks (1.3 mg/m(2) on days 1, 4, 8, 11, 22, 25, 29, and 32), plus bendamustine (90 mg/m(2) on days 1 and 4) and prednisone. The following cycles included bortezomib once weekly. Patients who were transplant candidates proceeded to stem cell collection after four cycles and the transplant was performed after six cycles. Patients who were not candidates for transplantation received up to nine cycles. Forty-two patients were transplant candidates and after six cycles, 50% achieved at least a very good partial response, with 24% having complete responses; 35 proceeded to a transplant, and the complete response rate was 54%. Seventeen patients continued up to nine cycles, and 57% achieved at least a very good partial response, including 26% with complete responses. The 2-year progression-free survival and overall survival rates were 62% and 86%, respectively. The safety profile was manageable, but stem cell mobilization was compromised in 35% of patients. In summary, this combination is effective in untreated patients, with an acceptable toxicity profile, but given the introduction of second-generation novel agents and monoclonal antibodies, the combination will probably be better reserved for relapsing patients, in whom stem cell collection is not needed, while cost-effective combinations with non-cross-resistant drugs continue to represent a medical need. This trial was registered with ClinicalTrials.gov, number NCT01376401.
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Affiliation(s)
| | | | - Laura Rosiñol
- Hospital Clinic i Provincial, Institut d'Investigasions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona
| | | | - Noemí Puig
- University Hospital of Salamanca/IBSAL, Salamanca
| | | | | | | | - Josep Sarrá
- Hospital Universitario Joan XXIII de Tarragona, Institut Català d'Oncologia (ICO)
| | - Enrique Ocio
- University Hospital of Salamanca/IBSAL, Salamanca
| | | | | | | | - Angel Payer
- Hospital Universitario Central de Asturias, Oviedo
| | | | - Javier de la Rubia
- Hospital Dr Peset and Universidad Católica de Valencia "San Vicente Mártir"
| | | | | | - Joan Bladé
- Hospital Clinic i Provincial, Institut d'Investigasions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona
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Huber S, Huettner JP, Hacker K, Bernhardt G, König J, Buschauer A. Esters of Bendamustine Are by Far More Potent Cytotoxic Agents than the Parent Compound against Human Sarcoma and Carcinoma Cells. PLoS One 2015. [PMID: 26196503 PMCID: PMC4721923 DOI: 10.1371/journal.pone.0133743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The alkylating agent bendamustine is approved for the treatment of hematopoietic malignancies such as non-Hodgkin lymphoma, chronic lymphocytic leukemia and multiple myeloma. As preliminary data on recently disclosed bendamustine esters suggested increased cytotoxicity, we investigated representative derivatives in more detail. Especially basic esters, which are positively charged under physiological conditions, were in the crystal violet and the MTT assay up to approximately 100 times more effective than bendamustine, paralleled by a higher fraction of early apoptotic cancer cells and increased expression of p53. Analytical studies performed with bendamustine and representative esters revealed pronounced cellular accumulation of the derivatives compared to the parent compound. In particular, the pyrrolidinoethyl ester showed a high enrichment in tumor cells and inhibition of OCT1- and OCT3-mediated transport processes, suggesting organic cation transporters to be involved. However, this hypothesis was not supported by the differential expression of OCT1 (SLC22A1) and OCT3 (SLC22A3), comparing a panel of human cancer cells. Bendamustine esters proved to be considerably more potent cytotoxic agents than the parent compound against a broad panel of human cancer cell types, including hematologic and solid malignancies (e.g. malignant melanoma, colorectal carcinoma and lung cancer), which are resistant to bendamustine. Interestingly, spontaneously immortalized human keratinocytes, as a model of “normal” cells, were by far less sensitive than tumor cells against the most potent bendamustine esters.
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Affiliation(s)
- Stefan Huber
- Pharmaceutical and Medicinal Chemistry II, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Johannes Philip Huettner
- Pharmacology and Toxicology, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Kristina Hacker
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Günther Bernhardt
- Pharmaceutical and Medicinal Chemistry II, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Jörg König
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Armin Buschauer
- Pharmaceutical and Medicinal Chemistry II, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
- * E-mail:
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20
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Peñalver FJ, Delgado J, Loscertales J, Sastre JL, Peña A, Olave MT, Osorio S, de la Fuente A, Salar A, Grande C, Pérez Ceballos E, Debén G, Echeveste A, Casado F, de la Rubia J, Lahuerta JJ, Mateos MV. Recommendations on the clinical use of bendamustine in lymphoproliferative syndromes and multiple myeloma. Eur J Haematol 2015; 96:532-40. [PMID: 26179864 DOI: 10.1111/ejh.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 12/18/2022]
Abstract
Bendamustine is an increasingly used hybrid alkylating agent that is active in lymphoid neoplasias via a novel mechanism of action. There are some pending questions about its use in clinical practice because of its developmental features. A consensus panel of several leading Spanish hematologists with broad experience in the clinical use of bendamustine has established recommendations for the management and treatment of hematological patients with bendamustine based on available clinical data and the experience of the participants. These recommendations address the dose and treatment regimen for different clinical indications, the management of toxicity, and support therapy. This article contains the conclusions of this consensus panel, which are intended to serve as guidelines for the use of bendamustine.
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Affiliation(s)
| | - Julio Delgado
- Department of Hematology, Hospital Clinic, Barcelona, Spain
| | - Javier Loscertales
- Department of Hematology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Jose Luis Sastre
- Department of Hematology, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Asunción Peña
- Department of Hematology, Hospital Universitario San Carlos, Madrid, Spain
| | - María Teresa Olave
- Department of Hematology, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Santiago Osorio
- Department of Hematology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Antonio Salar
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Carlos Grande
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Pérez Ceballos
- Department of Hematology, Hospital Universitario Morales Messeguer, Murcia, Spain
| | - Guillermo Debén
- Department of Hematology, Complexo Hospitalario de La Coruña, La Coruña, Spain
| | - Asunción Echeveste
- Department of Hematology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Felipe Casado
- Department of Hematology, Hospital Virgen de la Salud, Toledo, Spain
| | - Javier de la Rubia
- Department of Hematology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Juan José Lahuerta
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Victoria Mateos
- Department of Hematology, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain
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21
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Gentile M, Vigna E, Recchia AG, Morabito L, Mendicino F, Giagnuolo G, Morabito F. Bendamustine in multiple myeloma. Eur J Haematol 2015; 95:377-88. [PMID: 26085055 DOI: 10.1111/ejh.12609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 12/12/2022]
Abstract
The advent of high-dose melphalan with autologous stem-cell transplantation (ASCT), the availability of novel agents such as thalidomide, lenalidomide (immunomodulatory drugs or IMiDs) and bortezomib (proteasome inhibitor) and improvements in supportive care have allowed to increase overall survival in multiple myeloma (MM) patients; nevertheless, MM remains an incurable pathology. For this reason, newer agents are required for continued disease control. Bendamustine is an old drug rediscovered in the last decade. In fact, its unique mechanism of action with structural similarities to both alkylating agents and antimetabolities, but which is not cross-resistant to alkylating agents, has reawakened interest in the use of this drug in the treatment of MM. Studies have proven the safety and efficacy of bendamustine administered alone or in combination with new drugs in both upfront and relapse/refractory settings of MM patients, including those with renal impairment. Moreover, bendamustine has been successfully used as conditioning for autologous stem-cell transplantation. Finally, the use of bendamustine does not compromise peripheral blood stem-cell collection. This drug is generally well tolerated, with the majority of adverse events being due to myelosuppression. Non-haematological adverse events are infrequent and usually mild.
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Affiliation(s)
- Massimo Gentile
- Haematology Unit, Department of Onco-Haematology, A.O. of Cosenza, Cosenza, Italy
| | - Ernesto Vigna
- Haematology Unit, Department of Onco-Haematology, A.O. of Cosenza, Cosenza, Italy
| | - Anna Grazia Recchia
- Haematology Unit, Department of Onco-Haematology, A.O. of Cosenza, Cosenza, Italy
| | - Lucio Morabito
- Medical Oncology & Hematology Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, IRCCS, Milano, Italy
| | - Francesco Mendicino
- Haematology Unit, Department of Onco-Haematology, A.O. of Cosenza, Cosenza, Italy
| | - Giovanna Giagnuolo
- Haematology Unit, Department of Onco-Haematology, A.O. of Cosenza, Cosenza, Italy
| | - Fortunato Morabito
- Haematology Unit, Department of Onco-Haematology, A.O. of Cosenza, Cosenza, Italy
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22
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Stem cell mobilization and autologous stem cell transplantation after pretreatment with bendamustine, prednisone and bortezomib (BPV) in newly diagnosed multiple myeloma. J Cancer Res Clin Oncol 2015; 141:2013-22. [DOI: 10.1007/s00432-015-1984-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
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23
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Huber S, Antoni F, Schickaneder C, Schickaneder H, Bernhardt G, Buschauer A. Stabilities of neutral and basic esters of bendamustine in plasma compared to the parent compound: Kinetic investigations by HPLC. J Pharm Biomed Anal 2015; 104:137-43. [DOI: 10.1016/j.jpba.2014.11.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/14/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
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